TX HHS Form 3660. Request for Adaptive Aids. Medical Supplies. Minor Home Modifications or Dental Services/Sedation

TX HHS Form 3660: Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation is a crucial document that helps individuals with disabilities or medical conditions access necessary support services. This form should be used when an individual requires adaptive aids, medical supplies, minor home modifications, or dental services/sedation to improve their functional abilities and quality of life.

The form consists of two parts: Part A, completed by the individual or LAR (Legally Authorized Representative), and Part B, completed by the Case Manager. Key features include required information such as the individual's name, Medicaid number, address, and description of the item or service requested. The form also includes sections for describing functional limitations, benefits of the item/service, and non-CLASS resources.

This form is essential for individuals who require adaptive aids, medical supplies, minor home modifications, or dental services/sedation to maintain their independence and well-being. By completing this form, individuals can request necessary support services from the Texas Health and Human Services (HHS) Community Living Assistance and Support Services (CLASS) program.